Healthcare Provider Details

I. General information

NPI: 1356521686
Provider Name (Legal Business Name): DEBRA LEY PORTER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 AMHERST ST
BUFFALO NY
14207-2809
US

IV. Provider business mailing address

449 FAIRMONT AVE
N TONAWANDA NY
14120-2915
US

V. Phone/Fax

Practice location:
  • Phone: 716-515-2190
  • Fax: 716-515-2400
Mailing address:
  • Phone: 716-695-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: